The invention relates to maintaining the hand and or foot in reflex inhibiting positions to reduce hypertonicity. (increased muscle tone)
Individuals with hypertonicity are at risk of developing joint contractures. splinting is designed to avoid the formation of contractures or control contractures that are already present. Muscles are stretched and elongated through therapy. Muscle length needs to be maintained following therapy. The use of a splint fabricated of a rigid thermoplastic material is ineffective with hypertonic individuals because it is nearly impossible to maintain complete contact between the hand and/or foot and the rigid thermoplastic splint. The thermoplastic splint does not allow for the movements that are obligatory in the upper and lower extremities due to primitive reflex patterns.
Many types of rigid splints have been used in an attempt to control contracture. These splints have generally not prevented wrist and finger contractures or toe grasp in the neurologically impaired patient. Continuous stretch with use of these rigid splints does not elicit the desired response of decreased tone and increased range of motion. Most thermoplastic splints are of volar design. Splinting the volar surface stimulates the flexor muscle group increasing the already excessive flexor tone in both the hand, wrist and/or ankle, foot. Often, patients complain of discomfort and do not tolerate rigid splints.
The Metacarpal, Phalangeal, Interphalangeal, Abduction, Extension, Wrist Extension, Mobilization, Muscle Tone Reduction Splint, Type 0 reduces hypertonicity in the hand and/or wrist. The Metatarsal Abduction, Mobilization, Muscle Tone Reduction Splint, Type 0 reduces hypertonicity in the toes, foot and ankle. Traditionally, preserving the longitudinal and palmar arches to provide functional hand position is the goal of splinting. However, in the severely, neurologically impaired patients with hypertonicity, there is little functional hand use. Issues with this population include: 1.Increased tone in wrist and finger flexors and finger adductors 2. Increased risk of contracture development 3. Skin integrity and 4. poor hygiene. Flattening of the palmar and longitudinal creases promote finger abduction. Finger abduction will relax the hand and reduce hypertonicity throughout the hand and wrist. Hypertonicity is decreased when tone in the Lumbricale and Palmar interossei muscle groups is reduced. Tone in the wrist and hand is reduced when the Lumbricale and Palmar interossei muscles are held in a prolonged passive stretch, while stabilizing the metacarpophalangeal joints. Relief of hypertonicity in the hand and wrist is the goal of the METACARPAL, PEALANGEAL, INTERPEALANGEAL, ABDUCTION, EXTENSION, WRIST EXTENSION, MOBILIZATION, MUSCLE TONE REDUCTION SPLINT, TYPE 0 .
When used on the hand, our device incorporates a fiber filled palm and finger cushion with a thermoplastic dorsal stabilization lid. The cushion is covered with a soft absorbent material to maintain good skin hygiene; the fiber allows air to pass through the cushion to the patient""s hand. The cushion is gently positioned into the patient""s palm, the flared end of the cushion is placed in the thumb web space. The three abductor pads that extend from the cushion are pulled between the index and middle finger, the middle and ring finger and the ring and the little finger. The dorsal stabilization lid provides metacarpophalangeal joint stability and ensures the finger cushion placement. The dorsal lid has a relieved area over the metacarpophalangeal joints to prevent skin breakdown and promote comfort.
Locking mechanisms between each finger allow the abductor pads to be secured into the dorsal lid at the metacarpophalangeal web space. A band attached to both ends of the palmar cushion is placed under the dorsal lid. If the inferior end of the dorsal lid requires stabilization, it can be anchored to the band secured to the palmar cushion. If necessary, a dorsal wrist and forearm component may be added to address excessive wrist flexion. This is also made of thermoplastic material. It is attached at the base of the dorsal lid. It crosses the wrist joint, covering xc2xe the length of the forearm. It is secured at the distal portion with webbing.
Hypertonicity in the foot is characterized by a lower extremity extensor pattern, with increased tone in the toe, ankle and foot. The inversion reflex is triggered by pressure over the fifth metatarsal head. Pressure to the entire plantar surface of the metatarsal heads can result in toe grasp. The toe grasp reflex is demonstrated by marked increase of tone in the toe flexors and ankle plantarflexors. Relief of the toe grasp reflex as well as inversion and eversion reflex at the ankle is the goal of the Metatarsal, Mobilization, Muscle Tone Reduction Splint, Type 0.
The foot splint incorporates a resilient core material encased in an absorbent covering, secured with a series of hook and loop fastener. The device is placed under the ball of the foot with the metatarsal heads and lessens tactile and proprioceptive input into reflexogenous areas of the foot in the neurologically impaired patient. Hypertonicity is decreased when tone in the Interossei muscle group is reduced. Tone in the ankle and foot is reduced when the abductor muscles of the toes are held in a prolonged passive stretch while stabilizing the metatarsophalangeal joint. The soft strap that extends from the metatarsal roll is connected with a hook and loop fastener across the dorsum of the foot, just distal to the metatarsal heads. The four abductor pads that extend from the metatarsal roll are gently positioned between the great toe and the second toe, the second toe and the third toe, and the third toe and the fourth toe. Each abductor cushion is attached to the dorsal strapping using hook and loop fastener. The toes are held in abduction and the metatarsal joints are stabilized. This decrease of abnormal muscle tone, results in: decreased medial or lateral deviation of the forefoot which reduces toe grasp, reduction in inversion or eversion at the ankle and a decrease in ankle plantar flexor tone. When used in combination with an ankle foot orthosis, there is further tone reduction throughout the lower portion of the leg.